Failure to Provide and Document Scheduled Showers and Hygiene Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure that residents maintained good hygiene and received scheduled bathing and skin assessments as care planned. One resident, R20, was admitted with diagnoses including major depressive disorder, Parkinson’s disease, dizziness, anxiety, and difficulty walking. Her care plan documented an ADL self-care performance deficit due to activity intolerance and identified potential for skin impairment related to decreased mobility, hypertension, fragile skin, and poor safety awareness, with an intervention that her skin would be assessed weekly on her scheduled bath day. Her quarterly MDS showed intact cognition with a BIMS score of 15 and indicated she required set-up or clean-up assistance with showers and bathing. However, documentation reports for December 2025 and January 2026 showed “NA” for Shower/Bathing/Personal Care on her scheduled Wednesday and Saturday bath days. During a Resident Council meeting, R20 reported she should be receiving showers twice a week but was not, stating there were times she gathered her shower items and placed them on her overbed table, then fell asleep and woke up the next morning realizing no one had come to get her for her shower. She identified Wednesday and Saturday as her shower days. In a follow-up interview the next day, she stated she still had not received a shower, no one had come to talk to her about it, and she had not refused the shower. These statements, combined with the “NA” entries in the shower/bathing documentation, show that scheduled showers and associated weekly skin assessments on bath days were not consistently provided or documented for this resident as planned. A second resident, R75, was admitted with diagnoses including seizures, major depressive disorder, and difficulty walking. Her care plan identified an ADL self-care performance deficit due to disease process, general body weakness, impaired balance, limited mobility, and limited ROM, and noted potential for skin impairment related to hypothyroidism, polyneuropathy, and anticoagulant use, with an intervention that her skin would be assessed weekly on her scheduled bath day. Her quarterly MDS showed intact cognition with a BIMS score of 14 and indicated she was independent with showers and bathing. Documentation reports showed “NA” for Shower/Bathing/Personal Care on multiple dates in December 2025 and January 2026. During the Resident Council meeting, she stated she was not getting showers all the time and that even when she asked for them, she still did not receive them. CNAs and an RN described a process of reapproaching residents who refuse showers, notifying the nurse, and documenting refusals, and the DON stated CNAs are expected to ask residents about showers and notify nurses of refusals, with both nurses and CNAs documenting refusals. However, the record lacked documentation of refusals corresponding to the “NA” entries, despite the facility’s ADL policy requiring documentation of ADL care and/or refusals of care.
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